PSP as Distinguished from CBD, MSA-P and PD by Clinical and Imaging Differences at an Early Stage
PSP as Distinguished from CBD, MSA-P and PD by Clinical and Imaging Differences at an Early Stage
复制标题
DOI：
10.2169/internalmedicine.50.5954
复制
发表时间：
2011-01-01
影响因子：
1.2
通讯作者：
Abe, Koji
中科院分区：
文献类型：
--
作者：
Kurata, Tomoko;Kametaka, Satsuki;Abe, Koji
目的分析进行性核上性麻痹（PSP）与皮质基底节变性（CBD）、多系统萎缩-帕金森综合征（MSA-P）、帕金森病（PD）的临床特点，探讨PSP与CBD、MSA-P、PD的鉴别诊断及鉴别诊断的价值。结果PSP的临床特征为核上性凝视障碍、视动性眼震（OKN）损害和首次就诊时的福尔斯跌倒。在头部MRI上，PSP组中脑被盖萎缩比其他组更常见。PSP、CBD、MSA-P和PD-Yahr 1（-1）组123 I-MIBG心肌显像心脏与纵隔平均计数比值（H/M）均无降低，而PD-2、3、4和5组较PSP组明显降低。PD-3组左额叶视野CBF、PD-3和PD-4组右额叶视野CBF均低于PSP组，但其他组均呈下降趋势，与PSP组相比无明显下降。结论PSP即使在早期出现眼外运动（EOM）障碍、福尔斯、中脑被盖萎缩、（123）I-MIBG心肌显像H/M比值及8区CBF降低可作为PSP与PD-3或PD-4鉴别的辅助诊断方法。
Objective Because it is often difficult to precisely diagnose and distinguish progressive supranuclear palsy (PSP) from corticobasal degeneration (CBD), multiple system atrophy-parkinsonism (MSA-P) and Parkinson's disease (PD) at the onset of the disease, we compared the patients and clarified the features of these diseases.Methods We compared 77 PSP, 26 CBD, 26 MSA-P and 166 PD patients from clinical and imaging points of view including cerebral blood flow (CBF) in the frontal eye field.Results The clinical characteristics of PSP were supranuclear gaze disturbance, optokinetic nystagmus (OKN) impairment and falls at the first visit. On head MRI, midbrain tegmentum atrophy was much more frequently detected in PSP than in all of the other groups. Heart-to-mediastinum average count ratio (H/M) in iodine-123 meta-iodobenzyl guanidine ((123)I-MIBG) myocardial scintigraphy was not decreased in PSP, CBD, MSA-P and PD-Yahr 1 (-1), but patients of PD-2, 3, 4 and 5 showed a significant decrease compared with the PSP group. The CBF in the left frontal eye field of PD-3 group and that in right frontal eye field of PD-3 and PD-4 groups were lower than that of PSP group, although other groups showed a tendency without a significant decrease compared with PSP group.Conclusion PSP is distinguishable from CBD, MSA-P and PD even at the early stage with extra-ocular movement (EOM) disturbance, falls, atrophy of the midbrain tegmentum, and H/M in (123)I-MIBG myocardial scintigraphy, and the reduction of CBF in area 8 could serve as a supplemental diagnostic method for distinguishing PSP from PD-3 or PD-4.